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Organersatz in der Zukunft

Grenzen und Perspektiven

Organ assist devices in the future

Limits and perspectives

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Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Zur Behandlung des schwersten Lungenversagens und des kardiogenen Schocks werden im letzten Jahrzehnt zunehmend extrakorporale Organersatzverfahren (ECMO) eingesetzt, auch wenn die zugrunde liegende wissenschaftliche Evidenz immer noch gering ist und die Verfahren trotz aller technischer Verbesserungen weiterhin ein hohes Komplikationsrisiko aufweisen. Die Selektion der Patienten, die von einem solchen Organersatzverfahren am wahrscheinlichsten profitieren, stellt daher für Intensivmediziner und die anderen beteiligten Fachdisziplinen immer noch eine große Herausforderung dar. Neben dem Schweregrad des akuten Organversagens sollten hier die Ätiologie und Behandlungsmöglichkeiten der Grunderkrankung, die Komorbiditäten und der funktionelle Status des Patienten vom interdisziplinären Behandlungsteam umfassend evaluiert werden. Dabei sind auch ethische Herausforderungen zu bewältigen. Aufgrund der Komplexität der Verfahren und der hohen organisatorischen Anforderungen ist es sinnvoll, ECMO-Therapien in dafür besonders qualifizierten Zentren zu konzentrieren und eine umfassende wissenschaftliche Auswertung der Behandlungsdaten zu fördern.

Abstract

In the last decade, extracorporeal organ assist devices (extracorporeal membrane oxygenation [ECMO]) have been increasingly applied to treat the most severe forms of respiratory failure and cardiogenic shock, although the underlying scientific evidence is still limited and the methods carry a high risk of complications despite all technical improvements. The selection of those patients who most benefit from these devices is still a great challenge for intensivists and all other involved disciplines. Besides the severity of the acute organ failure, it is important to thoroughly evaluate etiology and treatment options of the underlying disease, comorbidities, and the functional status of the patients in an interdisciplinary team. This also includes ethical challenges. Because of the complexity of the treatment and the high organizational demands it is reasonable to concentrate ECMO treatments in specifically qualified centers and to promote a comprehensive scientific analysis of the treatment data.

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Author information

Authors and Affiliations

  1. Internistische Intensivstation, Department für Innere Medizin, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland

    R. Riessen

  2. Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland

    U. Janssens

  3. Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität Nürnberg, Klinikum Nürnberg-Süd, Universität Erlangen-Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland

    S. John

  4. ARDS- und ECMO-Zentrum Köln-Merheim, Kliniken der Stadt Köln, Krankenhaus Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland

    C. Karagiannidis

  5. Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    S. Kluge

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Correspondence to R. Riessen.

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Interessenkonflikt

S. John war Mitglied in einem Advisory Board der Firma Gambro/Baxter und hat von dieser Firma Vortragshonorare erhalten. C. Karagiannidis hat Reisekostenerstattungen, Vortragshonorare, Beratungshonorare und Forschungsgelder von der Firma Maquet erhalten. S. Kluge ist Mitglied im Advisory Board der Firmen Baxter, Fresenius und Xenios; er hat zudem Vortragshonorare von den Firmen Fresenius, Gambro, Sorin, und Xenios erhalten. R. Riessen und U. Janssens geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Riessen, R., Janssens, U., John, S. et al. Organersatz in der Zukunft. Med Klin Intensivmed Notfmed 113, 277–283 (2018). https://doi.org/10.1007/s00063-018-0420-3

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